Abstract
BackgroundFibrates are used especially in patients with hypertriglyceridaemia, a feature of the metabolic syndrome. Elevated LFTs are often observed in these patients perhaps related to fatty infiltration.AimWe wished to study changes seen in LFTs (GGT, ALT and ALP) following fibrate therapy and then determine associated factors.MethodsThis was a retrospective observational study in which data was collected from case notes of patients started on fibrates (n = 118, 2002–2008) in the lipid clinic at Good Hope Hospital and pre/post-fibrate lipid and LFT values were obtained. All biochemistry was performed on the Roche P-Unit using supplied reagents. Statistical analyses included t tests and regression analyses (factorised when quartiles were compared).ResultsOf the study population 106 patients were on fenofibrate; the remaining on bezafibrate. Significant lowering of GGT (p < 0.0001), ALT (p = 0.0014) and ALP (p < 0.0001) levels were observed following fibrate treatment. Baseline lipid (cholesterol, triglycerides and HDL) concentrations, alcohol intake, length of treatment, gender, concurrent statin treatment and diabetes did not correlate with these changes in LFT in a multiple regression analysis. Higher pre-fibrate GGT (p < 0.0001), ALT (p < 0.0001) and ALP (p < 0.0001) concentrations were associated with larger decreases in each of these tests respectively with the highest 2 quartiles (GGT > 57 IU/l, ALT > 34 IU/l and ALP > 94 IU/l) significantly different to the lowest quartile. The above associations remained significant even when the regression analyses were corrected for changes in lipid values (which did not show an association).ConclusionsFibrate treatment led to improvements in LFT, the greatest benefit seen in patients with higher baseline LFT values. It appears that baseline and changes in lipid values post fibrate treatment were not associated with change in LFT.
Highlights
Fibrates are drugs that are often used to treat patients with the atherogenic lipoprotein phenotype, characterised by increased triglyceride levels and decreased levels of High density lipoprotein cholesterol (HDL-C) (Staels et al, 1998a)
Fibrate treatment led to improvements in Liver function tests (LFT), the greatest benefit seen in patients with higher baseline LFT values
It appears that baseline and changes in lipid values post fibrate treatment were not associated with change in LFT
Summary
Fibrates are drugs that are often used to treat patients with the atherogenic lipoprotein phenotype, characterised by increased triglyceride levels and decreased levels of HDL-C (Staels et al, 1998a) This pattern of dyslipidaemia, central weight distribution, hypertension, and impaired fasting glucose/diabetes are characteristics of the metabolic syndrome. A two or three hit hypothesis has been proposed: damage initially caused by fatty infiltration associated with insulin resistance and obesity; the “first hit”. This is followed by injury resulting from mechanisms linked to oxidative stress and impairment of cellular regeneration; the “second and third hits” (Dowman et al, 2010). Elevated LFTs are often observed in these patients perhaps related to fatty infiltration
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